Category: Clinical Stones: Outcomes

MP13-17 - Calyceal diverticula (CD): diagnosis and management options in the era of non-contrast CT KUB

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective :

Calyceal diverticula (CD) are traditionally diagnosed by contrast studies such as IVU, CT urogram or retrograde. IVU has largely been abandoned as an imaging modality with the advent of non-contrast CT (NCCT). 


Methods :

We have retrospectively studied 48 patients diagnosed with CD since 2000 analysing the timing and modality of CD diagnosis, type and number of procedures, and success rate. Treatment failure was defined as the requirement for further intervention. 


Results :

All patients underwent a non-contrast CT at the time of presentation. Only 31% had a contrast study (IVU or CT urogram) before intervention.  52% required 1- 2 procedures before a diagnosis was established. In 27% the diagnosis was profoundly delayed, after an average of 5 interventions. The success rate for the first treatment is 69% if CD was diagnosed pre-operatively, compared to 0% if diagnosed at the time of the procedure, typically retrograde pyelography at the time of flexible ureterorenoscopy (FURS) for failed ESWL. For instance, FURS success as a first procedure with preoperative diagnosis is 50% while 0% if CD was diagnosed intraoperatively. 


Conclusions :

We believe that the delay in diagnosis of CD contributes significantly to the success rate and number of treatments. In the era of NCCT to diagnose kidney stones, contrast studies are essential if CD is a potential diagnosis, i.e. if NCCT raises suspicions or a stone is refractory to ESWL.

Faris Abushamma

Senior clinical fellow
Bristol Urological Institute, Southmead Hospital, Bristol, UK
Bristol, England, United Kingdom

Ito Hiroki

Bristol Urological Institute, Southmead Hospital, Bristol, UK
Bristol, England, United Kingdom

Omar Aboumarzouk

Urology Consultant
Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
Glasgow, Scotland, United Kingdom

Francis Keeley

Consultant Urological surgeon
Bristol Urological Institute, Southmead Hospital, Bristol, UK
Bristol, England, United Kingdom